0105-222 (SFD)FE
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # _ Lic. Class Exp. Date.
t,Date ' Z f 4 Signature of Contractor !=
'
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason
( ) I, as owner of the propertyA'r my employees with wagesfas their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). '-
(,) I am exempt under Section B&P.C. for this reason
Date `Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm. under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and .will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to be me subject to the
workers' compensation laws of California, and agree "be
of I should become
subject to the workers' compensation provisions•of Se Ion 3700 of the Labor
Code l'shall forthwith comply wi� IUP 1 ro4sio s.
jp�te:
Applicant-'—
/0,
pplicant
Warning: Failure to secure Workers' Compensation coveraged+S'•oWaf"ul and
shall subject an employer to criminal penalties and civil fines up !94100,000, in
addition to the cost of compensation' damages as provided fo ih Section 3706
of the Labor Code, interest and attorney's fees.
If
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. -
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the„City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and S to laws relating to the building
construction, and hereby authorize,`represe atives of.this'City to enter `upon
the above-mentioned property for'spectig pycp,,, 7
f�,$ig"nature (Owner/Agent) _-�;"'” Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �� «!, TRACT
III B240(123
JOB SITE
`ADDRESS
APN
>;e- 77-990 C.4i3(,YIX AR)R : "F3A
774-1354M1
OWNER ,'
CONTRACTOR / DESIGNER / EN &NEER 1•.
51470 AVENIDA7 Y:tori:l A-1% BUSTE 2, Rig,
5 � Z ��7� ��1''i�'� a A• I9�,��t�!;�� '3; �ii7'z � '�, �t�'L�
1,1k qLa ot. CA 92253
L&, WINTA, CA 92253
P760)564-1866 C.y $59
USE OF PERMIT
S17D r PIX.Rtk9')T I OPM 21rYf i'90,11]0? HLOC K W.A.X IA POOL OR t'3i:IV.f:"WAY
APk"'RS?.BCH
TRACT tkcaNZITRUCT ON 1,59.. D SF
�/�pGJ�1zRCy°1p�3f�yPy�j+�TIO 177.00S�?
1dYF.S�R'AA3lY7M Y'�w 4JY�d ��D..C1�f. B
E5t4Lt� TM) C f 5.r OF C:C)NF1`ftUCr10X
,041-90
{:0101TPd.1 CTIOM :PBZ 10 x,000.416.OW '$033.00
PLAN O11.12rI;;. PlCb'1�Qi1�.�51 3Y4� 1;�34.ti?
Y.E DEPOSIT 101-000-439-318 42U.00
r'M')WHANIOA,1.,If;'0 '101 ��C��21=C?GO - ���•�0
ELECTRICAL FEE« "" fl3�l -'600.47.0.000 SWIM
rJ
..
Ck J-Qt7'�i 1, 4.•f�f)0 } *143.9
STAt;143 MOTION FIR • #i(CeOW 101.000-2,41.000 .14180
1 d r�vv FES 101-000- 00
C1�11.8r.���'p�1��).1141ytCT3'yyVIIM pPACT
PPLN:IS:E, P1:.ftN 1 00lZ $. 00
SUB -TOTAL 00 V.fiat`T, 1 YJ "..1
,53C/.Sl
ogtd7Ct1 0' _ .ytt,.�ASI..
d.`.P�S1:i�, '...•. �-,P �• �.S.uCYST.Ye�% 0.T�r.L'9hA7PJ
RECEIPT
DATE ff
BY
D E NA �D
INSPECTOR
// I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_ _
_ % Q�
Underground Ducts
Ducts
Slab Grade
�
Retum Air
Steel
Roof Deck
`
Combustion Air
Exhaust Fans
O.K. to Wrap�
� [` j� [. � �; �,
F.A.U.
Framing
Compressor
Insulation=o'j.(�c�
c ST
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/ r
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel _
Set Backs
Electric Bond
Footings
Main Drain "
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final —
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
_
/ C_'
Electric Final
Heater Final
Water Piping
����8r `�
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
q'�xg s!fi
Pool Cover
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
_
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
'
Smoke Detectors
Temp. Use of Power
Final
O
Utility Notice (Perm)
_
I_ -- d L
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 7/2/01
No. 22202
Owner NameLendel Ventures, Inc.
No. 77-990 Street Calle Arroba
city La Quinta
Tract # B240U23 Lot # 12
APN # 774-135-023
Jurisdiction La Quinta
Permit # 0105-222
Log #
Zip 92253 Study Area
Square Footage 1594
Type of Development Single Family Residence No. of Units 1
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It
has been determined the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.05 X 1,594 or $ 3,267.70 the property listed above and that building
1
permits and/or Certificates of Occupancy for this square footage in this proposed project may how be'issued
Fees Paid By CC / Valley Independent Bank - Alfred Lench TE ephone 760=564-1866
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collectd/exeed by Annette. Barlow Payment Received $3,267.70
_ Check No. 247571
Signature �f
L
JOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
ibove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
ollect them on the DistrictCs)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
Certificate of Occupancy
City of La'Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING
77-990 CALLE ARROBA
R-3, U-1 Type of Construction: VN
Owner of Building: LENDEL VENTURES, INC.
Building Official
Bldg. Permit No.:
Land Use Zone:
0105-222
RC
Address: 51-370 AVENIDA BERMUDAS, SUITE 2,
RM.5
City: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: MARCH 1, 2002
03/04/2002 10:43 3458141
•
fir\ PAGE 02
/CITY F OUINTA
BUILDINGAF . DEPARTMENT
E
of
=y012
INSP4 TI REQUEST LINE
777-7153
0
NT U*RES -
_, LENDS 'VENTURES
Permit Number/
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 77-990 CALLE ARROBA
S.D. - PERMIT DOES NOT INCLUDE BLOCK
WALLS, POOL OR DRIVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK `y,1.z 57
!^DOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE.
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED•
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH GAS & GAS TEST
HEATING & VENT- AIC
BOND BEAM
O.K. TO WRAP g
GROUT ❑ 4' us,
FRAMING
INSULATION
PRE -ROOF
ABOVE HAS BEEN SIGNED I
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
t ABOVE APPROVALS 00 NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING